Experienced hospice and palliative care veterinarians typically manage thousands of patients with diseases affecting the liver, gall bladder, bile duct system, and consequently the pancreas and intestinal tract. Many of these diseases are chronic in nature with acute inflammation and infection causing symptoms that lead to veterinary visits, whether in the home or in a clinic setting. Specific diseases of the liver and gall bladder commonly seen in older pets by veterinarians in practice include hepatitis, cholangiohepatitis, cirrhosis, cancer, hepatic lipidosis, copper storage disease, gall bladder mucocele, and vascular disease.
Symptoms related to the dysfunction of the liver and bile duct include (but are not limited to) pain, lethargy, weakness, dehydration, weight loss, decreased appetite, vomiting, abdominal distention, jaundice, diarrhea, fever, increased thirst or urination, neurological signs (including seizures), and dark yellow-orange urine. Symptom management can be challenging at times, as many symptoms are non-specific and can be caused by other disease processes. Most pets will show signs of clinical disease when more than 80% of the liver has been affected. However, some cats and dogs with liver disease will not show any clinical signs.
Diagnostic tests performed on a blood or urine sample may reveal elevated liver enzymes elevated bilirubin, low protein levels, electrolyte imbalances, white and red blood cell count abnormalities, and prolonged blood clotting times (bleeding disorders). In addition, imaging studies may show evidence of liver enlargement, liver atrophy, cancer, gall bladder/bile duct thickening, pancreatitis, and bile stasis.
Medications used in the treatment of liver and gall bladder disorders may include some or all of the following:
- Pain medications for liver and bile duct discomfort, sometimes involving the pancreas
- Steroids to reduce inflammation or to treat immune-mediated diseases
- Anti-nausea medications for vomiting, drooling, and inappetence
- Antibiotics for primary and secondary infections
- Gastroprotectants (acid reducers) to prevent/treat intestinal ulceration
Supportive therapies used by veterinarians treating a patient with liver disease:
- Antioxidants – to help scavenge inflammation-induced free-radicals
- Zinc, glutathione, SAM-E, Vitamin C, Vitamin E, milk thistle
- Beta-carotene, coenzyme Q10, and super oxide dismutase
- Ursodeoxycholic acid (Ursodiol)
- Fluid therapy to treat dehydration
- Nutritional support – generally diets that are carbohydrate-rich, lower in fat; low protein ONLY when evidence of protein intolerance (neurologic signs) is present; low-salt if fluid is present in abdominal space; higher protein if albumin levels are low
- Dietary fiber (psyllium)
Although diseases of the liver are common in geriatric canine and feline patients, a definitive diagnosis is frequently not pursued in hospice patients. Therapies are directed at the palliative management of clinical symptoms and/or based upon suspicion of disease presence. Much can be done to provide comfort and quality of life to pets with liver and gall bladder disease during the hospice relationship, even when a definitive diagnosis cannot be reached. Humane euthanasia should be considered for pets when care to maintain quality of life is either no longer effective or financially feasible. If you have questions or concerns about your pet’s health and quality of life, please reach out to your veterinarian.
By: Dr.Christie Cornelius, BluePearl Pet Hospice https://pethospice.bluepearlvet.com